Driver's Ed -                                                     Driving Lessons                         Request/Consent Form                                              
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Students Name *
Contact Phone Number : *
Sms phone number:
Permit Number *
Permit issue date:
MM
/
DD
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YYYY
Email Address: *
What highschool do you attend?
Our driving lessons are from 2:15pm-9:15pm monday-friday and saturdays 8am-1pm. Please enter your availability for driving lessons. *
Do you have driving experience?
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I Will bring my active Learner's Permit and student card to every driving lesson! *
Required
I understand that if I'm part of the uds payment plan that I'm to bring $60 to every lesson until my full balance is paid for! *
I will give United Driving School a 24 hour cancellation notice, I understand that if I don't I will have to pay a fee of $30 *
I understand I will be receiving text/email reminders 2 days in advance for my lessons.
Clear selection
I will be bring my glasses or contacts if I have a B restriction on my learner's permit and I understand that United Driving School will not be able to give me my lesson if I do not *
I understand driving lessons are 2 hours long, unless there's a scheduling conflict
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I understand that I'm responsible for signing all in car sign in sheets and that my paperwork will not be sent to the Mass Dot until United Driving School has verified all required sheets for me to be certified. *
At the end of my 12 hour of driving I will have to pay United Driving School a Mass Dot fee of $15 for my certification and turn in my student card. *
I have reviewed this this form and swear (affirm), that the information I have provided is true and complete and I agree with its terms. *
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